| NPI | 1063885705 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNALISA FREDRICKSON Director 503-679-6314 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: OR 750417) |
| Enumeration Date | 2015-11-03 |
| Last Update Date | 2015-11-03 |